Reducing child and maternal mortality?

What do you know about the Millennium Development Goals?

To my shame I knew next to nothing until a few weeks ago, despite them being one of the most important agreements in the world.

Basically all countries have signed up to 8 targets to be achieved by 2015. These range from an end to poverty and hunger, and promotion of universal education and gender equality, through to HIV/AIDS prevention, environmental sustainability, and global partnership.

Noble aims – but quite a challenge!

My work in Cambodia is linked with two particular goals – number 4, to reduce the mortality rate for children under five, and number 5, to improve maternal health.

In July, all the VSO health workers in Cambodia and our volunteer assistants gathered in Phnom Penh to share our learning and refocus on why we are here. This year we looked specifically at these goals - reducing child and maternal mortality and morbidity in Cambodia – and what difference we can make as volunteers.

Where we are going seems to be well defined – starting from 1990, the aim is to reduce child mortality by two thirds and maternal mortality by three quarters by 2015. Only five years left then!

So where are we now? Agreeing on figures was surprisingly difficult. For example, according to the Central Asia Health Review, from 1990 the maternal mortality rate (the number of mothers who die as a result of childbirth, per 100,000 live births) fell from 900, to 590 in 1995 and 450 in 2000. But then the rate not only stopped falling, but had actually risen to 540 by 2005.
Does this mean that things are getting worse?

Not necessarily! In discussion it seemed that the increased rate may have more to do with better reporting than worse outcomes. Either way, it will be really difficult to meet the three-quarters reduction, which would be a rate of 225 in just five years time.

It’s worth pausing to take in what these numbers actually mean. Right now, for every 100,000 live births in Cambodia, 500 women die due to childbirth every year. If this doesn’t shock you, note that in neighbouring Vietnam the figure is less than a third of this, at 150 a year.

And in rich nations such as the Netherlands the rate is only 6.

This is because most maternal mortality is entirely preventable, a result of severe bleeding or haemorrhage and bacterial infections, pregnancy-induced hypertension (pre-eclampsia) and obstructed labour, along with unsafe abortions. These are often associated with other issues such as malaria, HIV/AIDS, complicated pregnancy and cardiovascular disease - and by the distance and cost of travelling to the nearest clinic.

This is truly a global scandal – women are still dying of completely preventable conditions in poor countries like Cambodia.

So what are we doing about it?

Encouragingly, we heard many examples of work VSO colleagues are doing to help prevent women dying unnecessarily.

Our guest speakers came from a small project called M’day Reak Reay, Kone Reak Reay (‘happy mother, happy baby’) who promote cooperation between midwives and traditional birth attendants. They gave us fascinating insights into how to work through the social hierarchy, getting permissions from every conceivable level, and how traditional birth attendants can actually play a useful role in identifying early complications and encourage women to go to hospital – which could literally save their lives.

We also had a great session on ‘behaviour change’ – if we are to make any lasting contribution then we need to work with women, families, communities and healthcare colleagues to change some of the factors which lead to maternal death. We reflected on what might influence us to change what we do (say washing our hands or wearing a moto helmet), and soon recognised that our own belief in a benefit or the support of those we trust can be far more powerful than lectures or threats from well meaning outsiders or ‘the authorities’.

Even our lunch break was a chance to learn: VSO recruits a number of nutrition advisors, who cooked us a traditional lunch whilst helping us to understand the importance of good nutrition in reducing mortality and morbidity. They demonstrated simple techniques such as putting tofu into soup and carrots or green leaves into the traditional bor-bor (rice porridge) - it was actually very tasty!

Our final session, bringing together all this background, challenged us to come up with practical ways in which we can make a difference to these goals as VSO volunteers. These included practical suggestions such as sharing our information, resources and skills, learning to work within the cultural hierarchies, role-modelling good practice, and getting the best from our volunteer assistants – and remembering that many improvements don’t need money. We also identified that we can be most effective when we ourselves are healthy and motivated – so I vowed to go off to nibble carrots and learn the 33 Khmer consonants.

To round things off, the Phnom Penh 5 O’Clock Blues Band (formed just a few hours earlier) brought some light relief to the evening, showing what the accompanying partners are up to whilst we are saving the world. My highlight was undoubtedly ‘The Development Blues’: “I godda big white four by four… Yeah I godda big white four by four… Need a four by four… to he-elp the poor”. Cutting!

A fascinating, , exhausting and inspiring 2 days – hopefully it will help us to make a difference.

Enemies of the People

He looks like a decent man: a kind, soft face, deep brown eyes, avuncular wrinkles. In fact to me he looks like a maths teacher – which is what he was.

Not the sort of guy, then, who would direct horrific torture and mass murder at Phnom Penh’s notorious ‘S21’ Tuol Sleng prison / death camp.

But that’s exactly what happened. The Extraordinary Chambers in the Courts of Cambodia have finally, 11 years after they were established, convicted the first member of the Khmer Rouge for crimes against humanity.

Comrade Duch’s story is remarkable for many reasons – the horrors committed by a seemingly ordinary man, his mysterious disappearance after the fall of the Khmer Rouge, and his bizarre chance discovery twenty years later by a British journalist.

Even his trial was extraordinary, undertaken by a hybrid of a local court supported by international officials and money, with both local and international judges. Duch initially admitted his crimes and expressed remorse, but then dramatically sacked his defense team and called for an acquittal.

The trial was also profoundly significant in that it finally allowed victims of the regime in Cambodia to face up to one of the killers.

Pol Pot, however, will never face justice – he remained at large in the north of Cambodia, near where I live and work, long after his regime had fallen. Ironically, the western countries who are so instrumental in backing the international court were the ones who helped ‘Brother number 1’ evade justice, covertly arming him as a buffer against communist Vietnamese troops who overthrew his regime in 1979.

But his deputy, ‘Brother number 2’ Nuon Chea, is still alive and is due to face trial along with three others next year.

At the Cambodian premiere of a new film about him, Enemies of the People, Cambodian investigatory journalist Thet Sambath tracks down Nuon Chea and gains his trust to the extent that he admits his actions for the first time.

The film includes fascinating insights such as Nuon Chea interpreting footage of Saddam Hussain as showing a misunderstood patriot, his strange moral code in wanting to avoid ''embarrassment'' by reenacting how he slit the throats of victims, and all the killers' constant references to following the hierarchy of command as a reason for obeying orders to murder.

But ultimately the film – and the trial - left me more confused than ever: how on earth can a country kill up to two million of its own people?

More illuminating was the post-screening debate, with co-director Rob Lemkin pushed to turn over his footage to the courts. Lemkin argued that Sambath was only able to get unique admissions of guilt on film by promising that these were for historical not judicial purposes, and that the future of truth and reconciliation depends on honouring such agreements.

Perhaps both approaches have their place – Cambodians, prompted by the top-down work of the courts and the more grassroots discussion of the film, may finally be starting to come to terms with their terrible recent history.

Kep, naturally

Natural beauty is abundant in Cambodia, despite the history of destruction under the Khmer Rouge and the more recent ravages of ‘development’.

My village of Thmar Puok is in the far north of the country and has plenty in the way of trees and fields, with forests and hills in the distance lining the border with Thailand. What we don’t have is water – no mighty Mekong as in the east, no vast Tonle Sap lake as enjoyed by residents of the central plains – and certainly no sea.

So when Katja suggested we extend a trip to Phnom Penh include a trip south to the coast, I jumped at the chance. A mere 14 hours of bus journeys later and we were dipping our toes in the balmy waters of the Gulf of Thailand.

Cambodia’s main seaside resort is Sihanoukville (or Kampong Som as everyone calls it), but it sounds about as attractive as a crab curry. The quiet and understated town of Kep, popular with Cambodians as much as western visitors, is about 100 kms east and a world away. Naturally we headed there, and we didn’t regret it.

Kep sur Mer, as it was, became a popular seaside retreat for French rulers in the early 1900s looking for a natural break from the sound and fury of Phnom Pehn. It’s easy to see the attraction – colonial villas and lodges were constructed right on the unspoiled shoreline and up the steep green slopes of the hill offering sweeping views out to sea.

Sadly Kep suffered badly under the Khmer Rouge in the late 1970s. Not only were buildings directly destroyed, but what remained of the town was stripped bare by starving people made desperate by the regime’s disastrous attempts to create an ‘ideal’ peasant society. By the early 1980s the town lay in ruins.

Reconstruction has taken time, and on a walk around the hill we saw several buildings which were just shells occupied by poor farming families on an semi-permanent basis. But there is a buzz again about Kep, with several developments underway which at least appear to be sensitive to the local people and environment.

The 10km walk around the base of the hill was truly uplifting, for the sea views and also for the unusual efforts made to provide a sanctuary for wildlife and a pleasant environment for visitors. Not only did beautiful butterflies flutter overhead and giant millipedes crawl over my boots, but none of this was sullied by the piles of plastic bags and polystyrene food wrapping which blight much of Cambodia – truly a breath of fresh air.

Similarly inspiring was our stay on Rabbit Island, a short boat ride off the coast. I was initially concerned by my guidebook’s warning not to get the wrong boat – apparently if you stray into Vietnamese territorial waters you are less likely to be greeted with a lotus flower than a heavily armed gunship, as neighbourly relations remain strained. I hope I’m wrong, but I fear that the recent discovery of oil in the Gulf of Thailand may not be good news for these relationships, for the local people or indeed for preservation of the area’s natural beauty.

There are no rabbits on Rabbit island– the name comes from the shape of the island rather than its fauna – but there is a lovely sandy beach, a row of simple wooden beach huts, and lovely clean water. At night we dived off the pier into the warm, clear sea to watch the air bubbles on our skin shine bright with phosphoresence– it’s a wonderful natural phenomenon (and one which only happens in unpolluted water).

Back on the mainland, there was time to admire the great white statue which dominates this part of the coastline – gazing out to sea is a beautiful Khmer woman, dressed as if to swim (Cambodians like to splash around, though they are a little constrained by the fact that few have been taught to swim, and that their culture demands you must remain clothed to enter the water). The woman was hardly wearing a skimpy bikini, but apparently the statue was initially controversial, with conservative visitors even draping extra cloth to protect her natural modesty.

So here’s to Kep sur Mer – let’s hope it can be a model for how Cambodia can balance its need for development whilst protecting its stunning natural beauty.

World Cup fever, Cambodian-style

It’s June, it’s the World Cup, and the dusty streets of Sisophon are, well, exactly as they were before.

Whilst the eyes of the world are on South Africa, the sporting preference of our average Khmer punter remains resolutely fixed on volleyball, cockfighting and flipflop pétanque. But last Saturday all this started to change…

VSO are supporting the www.1goal.org campaign, inspired by the historic first World Cup on African soil, and the conference of world leaders shortly afterwards. The campaign’s aim is simple: ‘education for all’. Shockingly, 73 million children in poor countries in Africa and Asia still don’t have access to a basic education. The campaign calls on leaders from developed nations to keep their promises on aid and for developing nations to invest in education.

I thought it might be a nice idea if we could arrange a football match in Sisophon to support the campaign, raising awareness of the message and gathering signatures. I figured it would be an even better plan to disappear to the other side of the country and persuade Jen, a young and enthusiastic education volunteer, to arrange the match whilst I was away. To my surprise she agreed, and set to work with gusto. After all, how difficult can it be to arrange a little kick around?

Well firstly, permission was needed to play on the main pitch in the town, a scruffy patch of land with branches lashed together as goalposts and a surface as smooth as national route 16 (that’s the bumpy dirt track to Thmar Puok). And we are also keen to leave something sustainable after the match is over – perhaps some new goalposts and nets.

The initial response is dispiriting – it appears that the ground has been sold by the local authority to a bank for development (scandalous, though I fear such shameful sell-outs aren’t limited to this country). And we learn that half the volunteer community – the Peace Corps, so the younger, fitter half– are off to Angkor Wat that weekend and can’t play.

But things improve – the director calls back to say he has spoken to the bank manager, we can play on the pitch, and he positively insists on having new goalposts – hurrah!

The opposition are the Provincial Office of Education, who boast a thriving sports department, so our rag-bag bunch of volunteers and local staff are a little intimidated. We arrange a practice match for 8am the day before, when it will be relatively cool. No-one turns up of course, and actually we didn’t actually have a ball, but we do manage to find each other for some ‘team-building and tactical analysis’ over omelettes in a local café. Later in the morning we even make it onto the pitch, having bought said ball, just in time to allow a group of laughing children to run rings round us.

In the afternoon I link with a local Khmer worker, Samut, who gives me an object lesson in how to get things sorted, Cambodian-style. New goalposts are manufactured and erected within hours. Sand to improve the penalty areas arrives within just 15 minutes of being ordered. The education department magic up some chalk to paint new lines. Alison even persuades some kids to pick up litter. The prejudice of many westerners is that Cambodians tend, frankly, to be lazy – they can certainly sleep at the drop of a pointy hat - but when they decide to do something, it happens at amazing speed. It’s impressive and frankly rather bewildering.

So, just a week after the initial idea was floated, the big day arrives! The education department are at it early: by 7am they have set up a tent, public address system, rows of red plastic chairs, and a range of banners (even if they miss the point a bit, focussing on the dire consequences of drug-taking). A parcel arrives from VSO with t-shirts for the teams and 20 footballs as raffle prizes. There’s even an ‘ice cream van’ (frozen condensed-milk on sticks from a tuc-tuc).

The arts school opposite arrive with a traditional band, and Paul, a volunteer music teacher, appears with his trumpet and serenades us with God Save Our Queen and The Great Escape. Kids from the school pack the touch line, and players bow to the respected guests. We even have a proper ref and try that thing where everyone shakes hands with everyone else. It doesn’t quite work as we don’t know when to stop shaking hands, but it’s a nice idea.

And then we’re off! To be honest the actual standard of the football itself is pretty modest – the opposition turns out to be of a certain age (and weight), and the VSO select team were clearly not selected for anything as logical as having played football before. But it’s great fun, hundreds of supporters and music, laughter, clapping and shouting from all around the ground.

So what did all this achieve?
* The 'Education for All' message was presented to hundreds of people in Sisophon, and we got an outstanding 340 signatures for the education petition (perhaps helped by the persuasive power of 20 footballs being raffled off at the same time)
* Relationships with the Provincial Office of Education were developed greatly, very good news for education volunteers in the province
* VSO enjoyed excellent publicity - the t-shirts and banner were prominently displayed, the footballs were very much appreciated, and volunteers from different programme areas (education and health) showed we can work really well together on a joint project
* The users of the football pitch - local kids and the Sisophon City team, now have a much better pitch, with litter cleared, sand laid and new goalposts and nets, which will be a lasting legacy of the event. I also hope that by encouraging the community to use the land, it more likely to remain there for them to use it, not to be taken over by another bloody bank
* And all of us had a great time
* And we won 6-4, with Oly Shipp the hatrick hero – result!

I want to ride my bicycle...

The transport revolution is two-wheeled, and Asia is the hub. I love cycling here, and it’s still by far the best form of travel. Today, however, was not my finest hour in the saddle.

I should have read the signs. With admirable gusto for a Monday morning I stride to work to start writing the report of our recent hospital assessment. My nurse colleague is delayed as there are no taxis – one comes along in a few hours so no panic. Happily the electricity seems to be working, so we do get going on the computer before it’s noodles and pumpkin time.

On our return from lunch we realise the power is a cruel hoax – the mains is actually off, it's just that the emergency generator is on to fan the visit of a city guest. As soon as his Lexus hits the dirt road the power is back off and our computing stalls. This of course also means that the wards have no power either; their needs are well down the hierarchy.

Several sweet coffees and immeasurable hanging about later we find another taxi to take us 50kms south to the larger sister hospital at Mongkul Barey to give ourselves a fighting chance for the next day. The bus is no longer an option: until a few months ago there was a once-a-day service, but then it mysteriously ceased and nobody seems to know why. Improving public transport is not yet a priority here.

So this morning I jump on a bike and potter along the couple of kilometres to the office. Not so fast! As I trundle along there’s a sinking realisation that the road is bumpy even by local standards – I have a puncture.

Fortunately there are plenty of repair shops, though in my hour of need they seem to all specialise in motos. But some friendly men in the market direct me to a little bike-fixing shack – in fact they even chase after me when I walk past it thinking it must be a derelict tractor store.

Now these guys are good, they can fix anything, so I’m confident I won’t wait long. The repair man is at least 107 years old but gets to work on my inner tube with youthful zest.

The first challenge is to inflate it to find the puncture. This is not so easy when VSO issue you with 1978 model Chinese rustbuckets whose valves have never been seen south of Laos. But the enterprising bikeman opens up his box of bits and builds a new pump from a wedge of plastic, a handful of nuts, a pin, some duct tape and the remains of his thumbnail.

This is not a quick process, but time is not a priority here. I bite my lip as other customers pitch up and he breaks off to pump tyres and grease wheels before sidling back to my job. I get this often: for example, once persuaded into a shared taxi, the driver thinks nothing of leaving you for an hour or so, before setting off in the wrong direction so he can first discuss the price of rice with his second cousin. And the trundling bus to Phnom Penh doesn't have to take all day, if we don't stop every hour for rice / toilets / greetings to the local peasantry. My time is not of value here – I need to chill and go with it.

So I’m happy that in less than an hour and only a few near-misses later the special pump is working. The innertube inflates to reveal a gaping hole. Of course at this point I would happily have just bought a new tube and been on my way, but they are much less wasteful here. Instead he winds the rubber around a metal cylinder, sands the puncture area with a rough-edged toilet-roll, applies tar, sets it alight (maybe he just escaped from Battambang circus?), blows on it, applies a patch, bashes it with the metal fork - and it’s mended.

Unfortunately it’s not that simple; on re-inflation the tyre promptly goes flat again – there must be a second puncture. At this point his 112 year old sister takes over. The process is repeated, with minor adaptations: she prefers a large candle for the fire trick, and decides that the best thing is to create a new valve made to superior Cambodian specifications.

I take deep breaths, and distract myself from the ticking clock and growing mountains of work which await me by trying to dissuade the bikeman’s great great granddaughter from her poking fingers in spokes game. Someone has to do it - interventions by the Cambodian Health and Safety Executive or Child Protection Unit are unlikely.

Eventually the job is done – at barely two hours, this must be the QuickFit of the east. And guess how much it costs? Well, would you believe it, the guy won’t take a cent. I argue hard until he takes a miserly 2,000 riels, less than half a dollar. I leave marvelling at both the ingenuity and the generosity my Cambodian hosts.

So finally I can get to work. I whizz along to the hospital, enjoying the whistling wind whisper through my hair as only cyclists can. Except that, sadly, it’s not the wind (and certainly not my hair), it’s the unmistakable hissing of a rapidly deflating back tyre...

Hospital Spot Check!

This has been my best week in Cambodia. And also the worst.

When the Director of the modest provincial hospital at Thmar Pouk asked me and Alison, the VSO nursing advisor, to spend the week with the Head of Nursing assessing the quality of the hospital, we were thrilled. This was our chance to get beyond the polite smiles and find out what care patients get here, and agree ways to make it better. Best of all, we were invited in.

After a breakfast of bananas – unfortunately bread supplies don’t often make it to this village – we step out to learn our first lesson: don’t start the morning after a monsoon, as the dust track becomes a treacherous, slippery mudbath. We should also have avoided the period after two of my translator’s piglets died. But Cambodia has a way helping you find calm and balance, and the happy singing of a little boy minding his grazing cows on the temple island got our visit off to a positive start.

Which was just as well, as I made the mistake of starting the inspection the litter-strewn grounds and deeply unpleasant wash blocks. No visit to the gents should leave you with this mixture of nausea and bafflement:

* Are these toilets clean?” “No they are very dirty” We agree!

* Yes, they are rather - when were they last cleaned?” “They are cleaned every day” “So this colourful crust and interesting aroma developed just this morning?”. Sarcasm doesn’t translate well.

* Ok, how often are they cleaned with bleach and a mop?” “Twice a month” “So when was this particular toilet last cleaned with bleach and a mop?” “Maybe last year?” Logical deduction not a strongpoint either.

* Different tack: “How could we make these toilets cleaner?” “We must teach patients to stop making them dirty”.

* Last try: “Who is responsible for keeping these toilets clean?” “That man sleeping in the hammock under the tamarind tree” “Is he tired from all the cleaning he does?” “No, he runs the hospital fruit and cigarette stall”. Nobody said this was going to be easy.

Things get better – both the hospital wells are broken, but there is hope that someone somewhere might know how to fix them – and even better, we think we know a donor who will pay for it.

Electricity also sparks debate: the hospital supply is unreliable , but it’s not a problem as there isn’t much equipment needing it. But hang on! Maybe the reason we don’t have much electrical kit is that we haven’t secured reliable power. I can’t help thinking that the Khmer language’s lack of a future tense may limit forward thinking.

It’s a baking hot day, and many patients are visibly uncomfortable. Happily all the wards have ceiling fans. Less happily, not a single one is on. All broken? Not at all - it’s just that electricity is “too expensive” (admittedly it does cost three times more here than in the provincial town). So the patients sweat and suffer, and everyone just accepts this, and my blood is coming to the boil...

I have a similar puzzlement when talking with patients - no matter how many times we ask what we can do to improve their experience, the only answer we get is ‘I want to be better so I can get back to my ricefield’. Necessary, of course, but sufficient?

Bless those midwives! Just as I am despairing, the serious matron shows me her spotless, well stocked and immaculately organised delivery suite. And rewards me with a rare smile. What's more, happy days, I have discovered that the hospital has a room with air conditioning!

And whilst the paediatric ward is a little rough round the edges, the bang and clatter outside remind us that a new one is being built. I have no idea why the US Army’s Corps of Engineers Pacific Command agreed to fund this, but we are happily accepting their generosity. I’m confident we are getting better value from their money than some of the usual things on their shopping list.

Outside, cheerful children clamber around the nearby playground – but on closer inspection we had to persuade them to leave, as the equipment was jaw-droppingly dangerous. Think of a slide which is so rusty it resembles a cheese-grater. Another one for our action plan –who might like to donate a new playground?

The medical ward is the busiest in the hospital, yet two of the three staff rostored to work have ‘popped out for a couple of hours’. Unfortunately they are rumbled as our inspection takes longer than that, and the story is modified– they are at a wedding and “may be drunk”. Understatement of the year. Meanwhile my blood pressure mounts again when I uncover old, bloodied swabs in the nursing trolley – and further when the discovery is met with a shrug. Meanwhile Alison finds that patients’ temperature, blood pressure and respiratory rate are neatly recorded for today. And tomorrow. “They can predict them” explained our translator. My esteemed nursing colleague did not concur. At least the drip stands are were not being used to dry fish today – I guess that’s progress?

The final ward has only one patient, a poor, emaciated woman – unbelievably she’s only 27. She knows she has TB, but we’re not sure that she really understands that the red crosses throughout her notes indicate she is also HIV positive. We ask if she is getting enough food, and she tells us she has no relatives to cook for her – only her young son. He’s the happy boy looking after the cows.

At the following day’s morning meeting, the Director harangues staff, who all intently study their flip-flops. We’re not entirely sure what is being said, but the word ‘worry’ is repeated, and we assume some details of our findings have already been shared – oh dear. After a sustained period of finger-wagging the Director fixes me with his gaze and my translator explains the big concern – cleanliness? drug supplies? staffing? financial irregularities? – so much choice. But no! - apparently the real anxiety is that they understand that the poor white man can’t find bread in the market, so they are arranging for the hospital ambulance to deliver me some regular supplies. It’s so sweet, unexpected, surreal, I don’t know what to think...

This week was just the start of course. We’ll now spend the next fortnight with the Head Nurse, discussing what we observed with each ward and department , and agreeing what they will do to make things better – and how we can help. The real crunch will come in August when we do it all over again – and hopefully find that standards are improving. I’m not sure if we’ll have working wells, functioning fans or decent documentation by then – and the poor lady with TB and her happy singing son may no longer be with us – but at least I may be enjoying my daily bread.

Moral Dilemma 3: Do You Copy?

From KFC (Khmer Fried Chicken) to my genuine Tushiba-branded fan, copying is not just an artform but also a way of life here. Just a bit of harmless fun, no?

The copy-cat culture certainly starts young. The education system, explains Kelsey, the other westerner in my village who teaches English at the high school, engrains lifting and plagiarism as soon as kids start class. Teaching usually involves simply copying from the board. And testing is no better - pupils just reproduce each others’ work, and this is completely tolerated if not encouraged. Thus the education system utterly fails to develop critical faculties and independent thinking in children – and so the culture of copying continues.

And so these copy-cat kids grow up into a counterfeit country - I had no idea before arriving here that there is no copyright law in Cambodia (or if there is it universally ignored), so anything goes. Knock offs of branded consumer goods are everywhere, from jeans and trainers to CDs / DVDs, from pharmaceuticals to books, from food and drink to artwork.

You do have to laugh sometimes - the ‘Toys Are We’ in Phnom Penh and ‘6 – 11’ store in Siem Reap show cheeky creativity, and imitation posters for Les Adventures de Tintin et les Khmers Rouges display a dark if witty ingenuity . But why then do so few Cambodians develop their own business ideas, rather than just cloning those of others?

So is it a bad thing?

I confess that part of me rather likes it. On a modest VSO allowance it’s rather good to buy a ripped Mika album for a dollar or a photocopied Lonely Planet for three. The fact that my guitar playing is more Friends Pheobe than Franz Ferdinand cannot be blamed on my faultless, forty-buck ‘Yamaha’ from Phnom Penh’s Russian market. I even bought a pair of Levi jeans in my village – “genuine fake, only ten dorra” explained the happy hawker. And they really were indistinguishable from the real thing, save the sewn up pockets and a little tightness in the crotch area.

But I have a nagging feeling that knowingly buying fakes isn’t a morally neutral act – can it really be ok to take part in this culture of copying?

5 Reasons why it’s completely fine to buy clever copies:

1. Everyone does it – even nice, ethical VSO-types. Not because we’re bad, just because that’s the system. You can’t buy originals of many goods such as CDs, clothes etc even if you wanted to – fakes are the only game in town. And as there doesn’t seem to be much in the way of a copyright law here it’s probably perfectly legal too.


2. Even if it’s technically not legal, it’s at worst a victimless crime – you wouldn’t buy the stuff at full (read rip-off) price, so all you’re doing is supporting poor folk trying to make a few bucks on the grey economy – where’s the harm?


3. Why pay more? Even if you could get originals, why should you pay five or ten times the price for say a book or DVD? Isn’t the money better in your (hard-working) pocket than in that of an already rich publisher or multinational music or movie conglomerate? When did you last see a starving pop star / Holywood actor?


4. The fakes here are good! Don’t swallow the propaganda about paying more for the real deal, everyone knows that Asian folk can copy anything, and do a jolly good job of it.


5. This isn’t just about cheap stuff, this is a way of fighting back against the great branding swindle that Western consumers have been subjected to for too long. Think Napster, Pirate Bay, Spotify; think open-source software; if you want to get really angry think drug companies charging so much that poor people die because they can’t afford the medicines, whilst they callously block cheaper substitutes. Reject over-priced brands, and help fight back against the great rip-off!

And 5 reasons why you should never support piracy:

1. It’s illegal. Whatever the detail of Cambodian statute, it’s clearly against international legal norms. The very least we should be doing is doing the right thing and obeying the law - especially those of us who are role-models in developing countries. And anyway, since when has ‘everyone else does it’ been a good reason for doing anything?


2. It’s a harmful racket, not a victimless crime. At best you are propagating a culture of copying which stifles innovation and inhibits major companies from investing as their intellectual property is not protected – thus damaging the development of the country. At worst this is this is piracy, sweat-shop produced goods, sold through exploited pushers, controlled by the same gangs who direct the drug and sex trades. Buy fakes and support organised crime – still a price worth paying?


3. You can pay the correct, legal price, and the money will go fairly to all those who have helped bring you the goods. Or you can pay the knock-off rate, save yourself a few bob, and you’ll have helped to deprive those who developed or designed the goods – the writers, artists, designers etc – of what is rightfully theirs. How is that fair, exactly?


4. You get what you pay for – books which fall apart, DVDs with crappy pictures, CDs of dubious quality – pay peanuts, get junkies. Worse, if you’re daft enough to buy fake medicines (which account for anything up to 80% of those on sale over the counter here), you’ll be lucky if it’s simply a placebo – more likely it’ll be heavily cut with harmful thickeners. And how do you feel when your plucky counterfeiters use their special skills to refill and seal bottles with unclean water or alter best-before dates on expired food – not such heroes now are they?


5. You know it’s wrong, so don’t do it.

Copy?